J Clin Monit Comput - Derivation of baseline lung impedance in chronic heart failure patients: use for monitoring pulmonary congestion and predicting admissions for decompensation.

Tópicos

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Resumo

The instantaneous lung impedance (ILI) is one of the methods to assess pulmonary congestion or edema (PCE) in chronic heart failure (CHF) patients. Due to usually existing PCE in CHF patients when evaluated, baseline lung impedance (BLI) is unknown. Therefore, the relation of ILI to BLI is unknown. Our aim was to evaluate methods to calculate and appraise BLI or its derivative as reflecting the clinical status of CHF patients. ILI and New York Heart Association (NYHA) class were assessed in 222 patients (67 ? 11 years, LVEF <35 %) during 32 months of frequent outpatient clinic visits. ILI, measured in 120 asymptomatic patients at NYHA class I, with no congestion on the chest X-ray and a low-normal 6-min walk, was defined as BLI. Using measured BLI and ILI values in these patients, formulas for BLI calculation were derived based on logistic regression analysis or on the disparity between BLI and ILI values at different NYHA stages. Both models were equally reliable with <3 % difference between measured and calculated BLI (p = NS). LIR = (ILI/BLI - 1) ? 100 % reflected the degree of PCE, or deviation from baseline, correlated with NYHA class (r = -0.9, p < 0.001) and could serve for monitoring. Of study patients, 123 were re-hospitalized for PCE during follow up. Their LIR decreased gradually from -21.7 ? 8.2 % 4 weeks pre-admission to -37.8 ? 9.3 % on admission (p < 0.001). Patients improved during hospital stay (NYHA 3.7 ? 0.5 to 2.9 ? 0.8, p < 0.0001) with LIR increasing to -29.1 ? 12.0 % (p < 0.001). LIR based on calculated BLI correlated with the clinical status of CHF patients and allowed the prediction of hospitalizations for PCE.

Resumo Limpo

instantan lung imped ili one method assess pulmonari congest edema pce chronic heart failur chf patient due usual exist pce chf patient evalu baselin lung imped bli unknown therefor relat ili bli unknown aim evalu method calcul apprais bli deriv reflect clinic status chf patient ili new york heart associ nyha class assess patient year lvef month frequent outpati clinic visit ili measur asymptomat patient nyha class congest chest xray lownorm min walk defin bli use measur bli ili valu patient formula bli calcul deriv base logist regress analysi dispar bli ili valu differ nyha stage model equal reliabl differ measur calcul bli p ns lir ilibl reflect degre pce deviat baselin correl nyha class r p serv monitor studi patient rehospit pce follow lir decreas gradual week preadmiss admiss p patient improv hospit stay nyha p lir increas p lir base calcul bli correl clinic status chf patient allow predict hospit pce

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